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  A509 Mayo (MMC 394)
  420 Delaware Street SE
  Minneapolis, MN 55455
  Phone: (612)624-7466
  Fax: (612)626-3994
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Home > Simulation Retreat Registration

Simulation Retreat Registration


Please provide the information requested in the following form. When finished, click on the submit button and the form will be automatically sent to SimPORTAL. You will receive an email confirming your registration.

First Name:
Last Name:
Department:
Campus Address:
Email:
Phone Number:
School:

Type of Participant:

Faculty
Fellow
Resident
Student
Staff
Other (please specify) :